Healthcare Provider Details

I. General information

NPI: 1811090723
Provider Name (Legal Business Name): ELIZABETH ANN HAYES LPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 GRAND AVE SUITE D
SACRAMENTO CA
95822-3466
US

IV. Provider business mailing address

2148 MADERA RD
SACRAMENTO CA
65825-0246
US

V. Phone/Fax

Practice location:
  • Phone: 916-922-9868
  • Fax: 916-922-7342
Mailing address:
  • Phone: 916-359-0876
  • Fax: 916-922-7342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License NumberPT4162
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: